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Opinion: AI doctors should be licensed. Here’s a framework to do that

Late last month, Utah’s Medical Licensing Board called for the immediate suspension of the state’s pilot program with the AI company Doctronic. The program lets a chatbot evaluate patients and recommend prescription renewals for nearly 200 chronic condition drugs, with the state planning to phase out physician review of each case.

The board said that it only learned about the pilot after it had launched. Its warning was blunt: proceeding without proper clinical oversight “potentially places Utah citizens at risk.”

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STAT+: Medicare is spending far less than expected on new Alzheimer’s drugs

People on Medicare are not getting the recently approved Alzheimer’s medications nearly as much as federal officials anticipated.

Uptake for the drugs, Leqembi and Kisunla, has been so muted that Medicare is not forecasting significant spending on them in 2026 or 2027, a spokesperson for the Centers for Medicare and Medicaid Services told STAT. It’s a dramatic shift from two years ago, when Medicare projected it would spend billions of dollars annually on Leqembi alone.

The lower-than-expected spending lines up with the challenges that the Alzheimer’s drugs have faced since their approvals, neurologists and Medicare experts told STAT: The intravenous medications are not easy to administer and require a lot of imaging; the population of eligible patients is limited; and the drugs continue to have little meaningful benefits while carrying a risk of severe side effects like brain bleeding.

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Animal skin disease confirmed in clusters of European men who have sex with men

Researchers in France and Spain have diagnosed a number of men who have sex with other men with dermatophilosis, a skin disease that normally infects livestock, even though the cases had no known exposure to affected animals. Cases have also been detected in Germany, one of the researchers told STAT. 

The clusters of infections are in some ways reminiscent of the emergence of mpox in 2022 in networks of gay men and other men who have sex with men. But people who have diagnosed some of these dermatophilosis cases describe a disease that is much milder in presentation. 

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STAT+: Provider, insurer groups rush to shape No Surprises Act arbitration rules

Any day now, the federal government is supposed to unveil a suite of changes to the No Surprises Act’s controversial arbitration process. Health care providers and insurers are racing to have the final word before the new rules are published, but one side is getting a lot more face time with officials. 

The four agencies crafting the Independent Dispute Resolution Operations final rule have held 20 meetings — mostly virtual — with industry groups so far this year. Just four of those were with health insurers or their trade groups. Thirteen were with providers or their trade groups, and another three were with other sectors. Stakeholders can request to meet with agency officials to highlight their priorities and submit relevant materials. 

The final rule has been a long time coming. The departments of Health and Human Services, Labor, Treasury, and the Office of Personnel Management released an initial version of the rule in November 2023. The proposed changes include tweaks to how claims can be grouped together, more transparency into pre-arbitration negotiations, and changes to fees.

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Endometriosis May Increase Risk of Birth Defects

Women with endometriosis have a small but significant increased risk for having babies with birth defects, such as those affecting the heart, gastric, genital, or musculoskeletal system, compared with women without the condition.

As reported in the Canadian Medical Association Journal, 6.3% of infants born to women with endometriosis included in the study had a congenital anomaly, compared with 5.4% of infants born to those without the condition.

Notably, only around 11% of the increased risk could be attributed to fertility treatment meaning that the condition itself is likely responsible for the small increase in risk. It suggests that endometriosis itself, likely through inflammatory pathways, oxidative stress, or epigenetic mechanisms, may directly disrupt fetal organogenesis.

Endometriosis is a chronic condition where tissue similar to the uterine lining grows outside the uterus, causing severe pelvic pain, painful periods, and often infertility. It affects an estimated 6.5 million women in the U.S., though many go undiagnosed for years.

“Endometriosis can trigger inflammation and oxidative stress, which have been linked to abnormal organogenesis in offspring. This disruption in organogenesis can lead to functional or structural anomalies that occur in utero, which typically develop in the first trimester of gestation,” write lead author Bailey Milne, Queen’s University, Kingston, Ontario, and colleagues.

“Some studies have reported an increased risk of genital defects among infants born to women with endometriosis; however, data are lacking on the risk of other congenital anomalies.”

To investigate this further, Milne and team conducted a large population-based cohort study using Ontario health administrative data, examining over 1.46 million births between 2006 and 2021. The aim was to quantify the risk of congenital anomalies in infants born to women with a pre-existing diagnosis of endometriosis.

Overall, 33,619 (2.3%) women included in the study had endometriosis. Women with endometriosis had a 16% increase in risk for having a baby with a congenital birth defect compared with women without the condition and 89% of this risk could be attributed to the presence of endometriosis and not possible confounding factors like fertility treatment. The most common associated defects were cleft palate, male genitourinary malformations, and cardiovascular abnormalities.

“Although this study contributes to accumulating data on a potential increased risk of birth defects for infants born to patients with endometriosis, the specific mechanistic pathways remain largely unknown,” write Milne and coauthors.

“A theorized mechanism by which endometriosis might increase risk of any congenital anomaly is through inflammatory pathways. The existing literature suggests a need for more comprehensive models that integrate genetic, epigenetic, and environmental factors to better understand this.”

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